Pre treatment morbidities among HIV infected patients attending Colombo HIV clinic during the period of January 2010 to June 2013. Buddhakorale K1, Jayasuriya NDV2, Somawardhana HPSP3
Sri Lanka was able to provide ART free of charge since December 2004. Sri Lanka has limited treatment options. The selection of an ART regimen in the presence of co morbidities such as tuberculosis, anemia, liver disease, renal disease, metabolic disorders and in ART failure is a challenge to Sri Lanka.
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To assess the pre treatment morbidities among HIV infected patients who were initiated ART during the period of January 2010 to June 2013 To assess the sociodemographic characteristics among the same population.
A descriptive cross sectional study . Carried out in HIV clinic Colombo. Exclusion criteria - patients less than 18 years old and the pregnant women. Data extracted from the Pre ART register ,ART register and patients’ clinical records . There were 148 patients.
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Data analyzed by SPSS version 16 .
Sex Distribution n=148
32%
Males
Females 68%
Figure 1: Sex distribution
0.4
37%
0.35
35%
0.3
<20
0.25 0.2 0.15
20-29 16%
30-39 12%
0.1
40-50
>50
0.05 0 Age (years) Figure 2: Age distribution
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Only 4% of the sample were illiterate. Majority (66%) were employed.
90% 77%
80% 70% 60% 50%
MSM
40%
Heterosexual
30%
Bisexual
20% 10%
16% 7%
0% Sexual behaviour Figure 3: Sexual behaviour
Pre ART Status
50%
44%
40% 30% 20%
21.50%
17.50%
17%
Stage 2
Stage 3
10% 0%
Stage 1
stage 4 Figure 5: WHO clinical stage
7%
12%
A ( Normal activity ) B (Bed ridden < 50%) C ( Bed ridden > 50% ) 81%
Figure 6: Performance scale
70.00%
64%
60.00% 50.00%
<18.5(under wt)
40.00%
18.5-25(normal)
30.00%
25.1-30(over wt)
20.00% 10.00%
15%
14.00% 7%
>30(obesity) Unknown
0.00%
BMI
Figure 7: BMI
60%
53%
50% 40%
<100 100-200
30% 20%
20%
15.50%
10%
201-350 11.50%
>350
0%
CD4 (cells/Âľl) Figure 8:CD4 count
Morbidities at Initiation of ART
OI
NO.
PCP
12
TB
22
Candidiasis
40
CMV retinitis
01
Cryptococcal meningitis
01
CNS lymphoma
01
Herpes zoster
07
Figure 9: Presentation of OIs
Commonest OIs 60% 48%
50% 40%
30% 20%
TB PCP
26% 14%
10%
12%
0%
Candidiasis Others
Ois Figure 10:Commonest OIs
10%
Oral candidiasis 90%
Oes. Candidiasis
Figure 12 :Candidal infection
Presentation No. TB
%
PTB
15
60%
EPTB
07
28%
Latent TB
03
Presentation of TB 12%
28%
12%
Figure11:Presentation of TB
PTB EPTB 60%
Latent TB
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51 patients had dermatological manifestations
Skin manifestations 80% 64%
PPE
60%
34.5%
HZ 40% 20% 0%
Fungal I. 13%16% 6%
dermatitis others
1%
Figure 13: Skin manifestations
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31 patients had STIs 21%
Commonest STIs 50%
45%
40% 30% 20%
HSV
26% 16% 13%
10%
S4L GW Others
0%
STIs Figure 14:Commonest STIs
80%
75%
70% 60%
<8
50%
8.0-10.0
40%
10.1-11
30%
>11
20%
10%
3%
8%
12%
0%
Unknown 1%
Hb (g/dl) Figure 15: Hemoglobin level
90%
84%
80% 70% 60%
<100
50%
100-150
40%
>150
30%
Unknown
20%
10% 0%
4%
11%
1%
Platelet count ( x10 3 /ul)
Figure 16: Platelet count
Other morbidities
No.
%
DM
10
6.8%
Hyperlipidemia
06
4%
IHD
02
1.3%
HT
02
1.3%
Renal impairment
01
0.7%
Hepatic impairment
01
0.7%
Psychiatric dis.
02
1.3% Figure 17 : Other morbidities
Regimen stared
NO.
%
AZT+3TC+EFV
87
58%
AZT+3TC+NVP
19
13%
AZT+3TC+LOP/R
02
1.5%
TDF+FTC+EFV
38
26%
TDF+FTC+LOP/R
02
1.5%
Figure 18: ART regimes
Out come at the end of September
2013 N=148
100%
87%
80% 60% 40% 20% 0% OT1
3%
5%
5%
OT2
Death
LFU
Figure 19: Out come
PCP (44%) HIV encephalopathy (14%) Renal failure (14%) Syndrome of Inappropriate secretion of ADH/ SIADH (14%) Unknown (14%)
Probable cause for death (n=7)
Pregnancy(25%) NNRTI hypersensitivity (75%)
Reasons for switching to second line therapy (n=4)
Opportunistic infections are more commonly identified among study population than other co morbid factors. Majority of patients were initiated ART at a higher CD4 count (mean count 233cells/µl) How ever the most possible cause for more opportunistic infections in an ART era, can be due to late diagnosis.
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Most of the morbidities identified among study population can be prevented by early diagnosis and initiating ART at a higher CD4 count. To prevent late diagnosis;
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HIV should be considered as a differential diagnosis when a patient presents with oral candidiasis, TB, atypical pneumonia, certain dermatological conditions, unexplained anemia ,thrombocytopenia etc. Scaling up screening of HIV among most at risk population and other vulnerable groups.